Provider Demographics
NPI:1063510675
Name:FISHER, JUDITH (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ANDOVER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5076
Mailing Address - Country:US
Mailing Address - Phone:978-691-5690
Mailing Address - Fax:978-691-5693
Practice Address - Street 1:519 US ROUTE 1
Practice Address - Street 2:UNIT 2
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1640
Practice Address - Country:US
Practice Address - Phone:207-351-1266
Practice Address - Fax:207-363-4905
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10992207N00000X
ME015408207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
400918OtherHARVARD
NH01Y002813NH01OtherANTHEM NEW HAMPSHIRE
2432636OtherAETNA
ME039354OtherANTHEM MAINE
NH01Y002813NH01OtherANTHEM NEW HAMPSHIRE
2432636OtherAETNA
NHRE6051Medicare PIN